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Abortion in New York City

If in 1969, you were a 21-year-old college student in Illinois, and you wanted an abortion, it was an expensive operation -- and an illegal one. Four states had passed laws allowing for some exceptions to the ban, but even in those states, abortions were not readily available. It was not unusual for a young woman to spend her life savings -- and perhaps those of her friends -- to end an unwanted pregnancy.

A year later, New York State passed the nation's first law legalizing abortion without restriction up to the 24th week of pregnancy. It was pioneering legislation, but only a few states would follow. A young woman in Illinois would still need to raise a large amount of money either to travel to New York or to find an illegal abortion.

When the United States Supreme Court overturned state restrictions on abortions with Roe v. Wade in 1973, abortion became legal everywhere for everyone. Over the years, more and more states have passed more and more restrictions, and fewer and fewer clinics operate in the heartland, making abortion difficult to obtain in most places. But New York laws are still among the most liberal.

This fall, with two newly appointed conservative justices in place, the Supreme Court is poised to reconsider Roe v. Wade. Illinois is among the 17 states that will reinstate an abortion ban if Roe is overturned. The U.S. Senate and House recently passed different versions of a bill called the Child Custody Protection Act, which, if reconciled between the two legislative branches, would criminalize the transport of minors across state lines for an abortion by anyone except a parent.

The issue of abortion remains so contentious that when the Food and Drug Administration
announced
last week its approval of the over-the-counter sale of Plan B - a morning-after
contraceptive bill - for women 18 and older, both abortion opponents and supporters took issue. The president of Pharmacists for Life International, Karen Brauer, objected to the availability of the drug. She told WDC Media (a Christian news agency) that Plan B "operates significantly to stop the life of an early human." The National Organization for Women applauded the approval by the FDA but said the pills should be available for minors as well.

Whatever happens nationwide, New York's pioneering laws are likely to remain in effect, no matter how little company they have. Meanwhile, in Illinois and much of the rest of the country, young women will still have to raise the money to go elsewhere to end pregnancies. Often that elsewhere may well be New York.

Views Of The Public, And Public Officials

New York City is likely to remain one of the easiest places in the country to have an abortion. Much of this may be a reflection of the prevailing attitudes here, as demonstrated in the positions of public officials (and candidates).

Laws concerning abortion are state-wide. The state-wide candidates for office
who are widely given the best chance for winning in this year's election make
a point of displaying their pro-choice credentials. On Democratic gubernatorial
candidate Eliot
Spitzer's Web site, he lists his endorsement by NARAL, the pro-choice group
and reprints his speech to them.

Besides supporting New York's liberal abortion laws, he promises that if Roe v. Wade is overturned by the Supreme Court, he will review state laws and strengthen any that the court decision will throw into jeopardy. He also supports easy access to emergency contraception and the right to late-term abortion.

Despite Hillary Clinton's statements in a January speech about teen celibacy,
prayer, and the "tragic choice" that abortion represents, her
campaign Web site proclaims a solidly pro-choice position, though she does
repeat that abortion should be "safe,
legal and rare."

It is more difficult to find the views towards abortion of the Republican candidates for these offices; abortion is not mentioned on their Web sites, no matter what their position. But in a debate on August 9th between the two Republican candidates for U.S. Senate, John Spencer said he would restrict abortion except to save the life of the mother, while his opponent, Kathleen Troia McFarland , a former Reagan official, said she supports abortion rights.

The Republican candidate for governor, John Faso, has worked to restrict abortion
when he served in the state assembly. His positions are outlined not on his
own Web site but by a Westchester
County pro-choice group.

It is worth noting that Faso is reportedly the first anti-abortion candidate for governor in either party in more than 25 years.

No matter who becomes governor, though, measures to restrict abortion in the state are unlikely. The State Assembly remains solidly pro-choice. "The Assembly has been at the forefront of protecting and ensuring women's rights in New York State," says Eileen Larrabee, spokeswoman for Assembly Speaker Sheldon Silver. "Obviously it's something we need to continue to push to ensure those rights are not chipped away."
The Assembly Speaker's staunch pro-choice stand frustrates Lori Hougens of the New York State Right to Life Committee. "New Yorkers support a ban on partial birth abortions and are in favor of parental involvement legislation, which would make sure parents know that their underage daughters are having an abortion," she wrote in Gotham Gazette. "But in the Assembly, Speaker Silver will not allow a vote on the floor for legislation banning partial birth abortions or requiring parental notification."

The State Senate is more conservative, but the abortion issue doesn't come up there, says Mary Alice Carr of NARAL Pro-Choice New York. Without Assembly support, a bill would not reach the governor's desk, so passing restrictions would be pointless. "A lot of legislators," says Carr, "don't want to deal with the issue."

One Out Of Every Ten Abortions

Despite restrictions and a dearth of clinics in most states, abortion remains
a common experience across the country. One out of three American women has
had an abortion by age 45, reports the Guttmacher
Institute, which tracks abortion laws and statistics. The majority of women
who get abortion already have children (61 percent) and are poor (57 percent).
Women of color make up most of those who get abortions: While 41 percent are
white, 32 percent are black, 20 percent are Hispanic and 7 percent are other
minority races.

But New York Magazine has called New York City "The
Abortion Capital of America." Women come here for the procedure. "New York
City has the least amount of practical barriers," explains Carr of NARAL Pro-Choice
New York. One out of every 10 abortions in the nation is performed in New York
State - 120,000
abortions performed in New York State in 2003, according to the New York
State Department of Health. Seventy percent of those are performed in the city,
where there are 34 major clinics.

Medical training

Unlike other parts of the country, if you go through a residency in obstetrics/gynecology in New York City, you'll learn how to perform abortions. That's because Mayor Michael Bloomberg, shortly after taking office in 2002, ordered city hospitals to include such training. There's a similar requirement in the California university system, but nowhere else.

It might seem obvious that someone going into obstetrics and gynecology would
learn how to perform an abortion, if only for emergencies (such as completing
a miscarriage). In fact, the accrediting agency for graduate medical education
has required such training since 1995, says Lois Backus, director of Medical
Students for Choice, a national organization promoting reproductive and
abortion education for physicians in training. Despite those regulations, only
12 percent of the OB/GYN residency programs train first first-trimester abortions.
Only 7 percent train for second-trimester abortions.

Backus says that her organization is particularly interested in making sure medical students, not just specialists, receive education on family planning and abortion. "No more than two-thirds [of medical schools] provide any required medical education on abortion," she says. And those schools often focus "only on the ethical issues" not on clinical practice.

Most hospitals across the country do not provide abortion services, so medical students would have no opportunity to learn about the procedure firsthand. That effectively blocks training for medical students.

For medical students "New York City is actually fairly good and largely due to Mayor Bloomberg," says Backus. Unlike most other places, "there is hospital-based abortion and family planning, that students gain access to as they go through medical training. In most of the rest of the country, that clinical care is not provided in hospitals where students receive most of their training."

Another barrier for medical students involves an "opt-out" clause for hospitals. In 43 states, hospitals may refuse to participate in abortion services. In New York State, they cannot. "For example, with a religious hospital, if a woman comes in and is miscarrying and needs an induced abortion to complete the miscarriage, the hospital can't refuse to provide those services in New York," says Rebecca Wind of the Guttmacher Institute. "In most other states, they can." In those states, the woman would be transported to a facility that would do it.

That is not a rare scenario, says fourth-year Mount Sinai medical student Erika Levi. She's the regional coordinator of Medical Students for Choice. "I've seen many women coming in with a miscarriage who need a D and C [dilation and curettage-a surgical abortion]," she says. "It happens often enough to be an issue."

She thinks that she and most medical students in New York City receive a good education in reproductive issues including abortion. Because most of the hospitals do offer abortions services of some kind, students also learn about the procedure-and the women who undergo it-firsthand. In other parts of the country Levi says it is different. If the procedure is mentioned at all, it is in a pejorative manner.

Protesters

Vocal and sometimes violent protesters in many parts of the country make abortion more difficult for young women and sometimes dangerous for providers. From time to time, New York City has had its share of demonstrators, especially at the Margaret Sanger Center in Manhattan. That clinic sees some 11,000 abortions a year.

Carr of NARAL credits the tough enforcement by state Attorney General Eliot Spitzer and by Manhattan D.A. Robert Morgenthau. Strict enforcement of laws protecting clinics and their personnel has helped maintain safety. The possibility of violence is not just paranoia. Abortion clinics have been subject to bombings and staff have been shot. The Attorney General's Reproductive Rights Unit aims to keep clinic violence and intimidation at bay. "Peoples' safety is at risk," says Carr. "Laws are only as good as the people that enforce them."

Crossing State Lines

At present, most of the states near New York City also have liberal abortion laws, and facilities are available. However, nearby Pennsylvania and Rhode Island require parental consent for minors. Thirty-four states have parental consent laws, and 24 mandate a waiting period between initial consultation and the procedure. Second-trimester abortions are also more available and less expensive in New York City than elsewhere.

For some minors, the barriers to abortion may soon be insurmountable. If federal legislation called the Child Custody Protection Act becomes law, girls who don't want to consult their parents who come from Rhode Island, Pennsylvania and other parental consent states will not be able to do so accompanied or aided by an adult (unless the adult wants to chance prosecution).

If Roe v. Wade is overturned, 17 states plan to put into place highly restrictive
measures that will affect all women, not just minors. Of those, only Delaware
is near New York, so the impact might not be the same as it was when New York
stood alone with abortion on demand as it did in 1970. Before Roe v. Wade, women
from out of state accounted for 61 percent of abortions, according to New
York Magazine.

"We would anticipate a situation that we saw pre-Roe v. Wade," says Carr of NARAL: "a haven for women across the country. New York would be taking on the burden of a lot of other states that outlaw abortion."

But that already happens to some extent. Abortion is now legal across the country "in theory, not in practice," says Carr. Some 87 percent of counties across the nation have no abortion provider, according to the Guttmacher Institute. It's particularly hard for low-income women and those who do not speak English. "Roe does not exist in practice for a lot of women in this country," says Carr.

The restrictions elsewhere already bring young women to New York for abortions. The Sanger clinic has reportedly seen an uptick of 21 percent more out-of-state women seeking abortions.

Paying for Abortion

For low-income women in New York, state Medicaid covers abortion services, because the Hyde Amendment, passed in 1976, restricts Federal Medicaid funding for abortion except in the cases of life endangerment, rape or incest.

Minors in New York can be covered by Medicaid. Some clinics offer sliding scales, so teens who can't afford the full fee (about $350 in the first trimester), can still obtain an abortion.

Whether the easy access to abortion in New York is a good thing is a matter of individual opinion. For the time being,, the procedure will remain easily accessible and affordable to the women in the city.

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